Acute ischemic stroke revealing an internal carotid artery dissection in a 12-year-old child: case report and literature review

Abstract

Introduction and importance: Internal carotid artery (ICA) dissection is a known cause of stroke but is often underdiagnosed in pediatric patients. Pediatric ischemic stroke significantly contributes to juvenile brain injury. Currently, there are no universally accepted guidelines for managing stroke in children. Case Presentation: We report the case of a 12-year-old girl who was admitted with sudden left hemiplegia and aphasia. Imaging revealed right carotid artery dissection and ischemic stroke in the right middle cerebral artery territory. She was managed with aspirin (75 mg/day) and enoxaparin (3000 IU/12 h) and remains under observation with persistent symptoms. Clinical discussion: This case highlights the difficulty in diagnosing ICA dissections in pediatric patients and the lack of clear guidelines for their management. The use of aspirin and enoxaparin represents an empirically-based therapeutic approach, underscoring the urgent need for further research to better understand the risk factors and pathogenic mechanisms of this condition. The persistence of symptoms in our patient also emphasizes the importance of close monitoring and individualized management. Conclusion: ICA dissection in pediatric stroke is hard to diagnose and treat. Research, empirically-based treatments, and personalized monitoring are crucial for better management and outcomes.